Transforming Dermatology Care Pathways

Storm ID has been commissioned to prototype a new digitally enabled care model for Dermatology across three health boards in Scotland.

The service will be developed using the Lenus Health Platform; designed to enable new care pathways for a range of long-term conditions that combine remote monitoring of patients with machine assisted clinical decision support. This, in turn, will help meet the policy objective of shifting the balance of care from the acute setting into the community.

The landscape for healthcare is changing. There is a huge surge in innovation taking shape within the health tech space, which is resulting in a rapid growth of digital health data generated by patients. This is driven from a range of sensors, connected hardware and apps that can measure almost any aspect of physiology as well as collect qualitative data from patients. Yet the value of this consumer tech in delivering operational efficiencies and improved health outcomes will only be realised once the data is connected into new care pathways and integrates with machine learning and other decision support tools.

In August we announced our participation in a competition run by NHS Scotland, Scottish Enterprise, Innovate UK and the Scottish Government to explore how we might use digital technology to help alleviate demand on dermatology services in Scotland.

Over the next 12 months the objective is to operationalise a new service model, which takes a two-pronged approach for primary and secondary care: Virtual Consultations and a Primary Care Triage App. The service will be deployed in NHS dermatology services in Greater Glasgow and Clyde, Forth Valley and the Highlands.

Thanks to funding from Scottish Enterprise and the Scottish Government, NHS Scotland has been able to work at a much earlier stage with companies from across the UK and Europe in developing in collaboration with them, their initial ideas to address the problems that our staff have identified as requiring innovative solutions to improve patient access and outcomes, whilst also enhancing the working lives of staff.

With Dermatology a service under increasing pressure due to rising patient demand, the Small Business Research Initiative with support from Innovate UK has enabled clinicians from different parts of Scotland to work initially with five companies to help develop and assess their proposed ideas, which have then gone forward for consideration to be prototyped within NHS settings.

With all five final proposals having potential for trailing in the NHS, it was a challenging task to prioritise those two that would be funded to progress

We are confident that the two we have chosen will prove to be successful, and we look forward to working with the team from Storm over the coming 12 months.”

Our service model is designed to reduce the number of face-to-face contacts for identified patient cohorts in secondary care and improve the triaging of patients in primary care.

The Virtual Consultation service will consist of two separate interfaces and will run asynchronously between patients and healthcare professionals, using our Lenus digital health platform to enable the secure sharing of patient generated data in a GDPR compliant way and have the patient data connected to statutory data sources.

Patients will be able to share images of skin conditions and qualitative information with a health professional through a Patient Mobile App negating the need for a routine clinic appointment. This app will also help educate patients about their skin conditions through guided access to self-management content and peer-to-peer dermatology forums.

A service interface for health professionals will enable patients to participate in a virtual consultation with hospital based clinicians, following the provision of a prioritised referral list of new cases, for review by the Dermatology consultants.. This prioritisation will be driven by integration of a neural net (a type of machine learning).

This approach is in line with changes taking place across the globe for:

Care delivery centred around the hospital and physicians’ offices may be transformed to be located more conveniently for patients, meaning closer to home or even at home. Especially connected health solutions, such as mobile health apps and telemedicine, are deployed in this context in order to improve individuals’ ability to manage their health and the health of the community.”

The second part of the prototype solution service model is a Primary Care Triage App, which will offer a clinical decision support tool for GPs to aid the diagnosis of skin conditions and support greater adherence to established care pathways. This mobile app will be available to a cohort of GPs who will take a series of images of the patient’s skin condition and submit the image to a neural net for a diagnosis. The neural network will provide a probability score against likely diagnoses and provide the GP with access to the supporting referral guidance that is currently available for that condition to help the GP select the correct pathway.

“I am hopeful that this collaboration can deliver a fit-for-purpose solution that can be used to improve delivery of the Dermatology Service to the benefit of our patients across Scotland,” says Dr Colin Morton, Clinical Lead. He continues “Choosing the two successful bids was a challenge from the high quality proposals received. Patients and service providers have the chance to create novel technological solutions with the two successful companies and I look forward to working closely with them during the forthcoming year.”

The service model has scope well beyond Dermatology. The underlying technical architecture, systems integration work and knowledge gained from operationalising this service will be transferable to other condition types. Replicating this model could enable care to be delivered outside the acute environment, and instead open up opportunities for care to be delivered at home or within a community setting.

We are delighted to have been appointed to work with the NHS to operationalise this service for Dermatology across three health boards. The project is aligned with our ambitions for the Lenus Health platform to support new models of care for long-term conditions that are preventative and continuous, exploit new digital tools that empower the patient to be part of their own healthcare and integrate data with statutory systems and algorithms to offer clinical decision support. It’s undoubtedly a big challenge to operationalise this service properly with both health professionals and patients but one we look forward to in partnership with health professionals over next twelve months.